Effective triage of patients with acute pancreatitis depends on the ability to accurately predict severity.
Predictors (for example, APACHE II score of > 8) have been tested against wide-ranging definitions of severity.
In order to ensure uniformity in defining a severe course of acute pancreatitis, the Atlanta symposium of 1992 adopted all-encompassing criteria.
In this study, researchers from the United States assessed the prevalence of each Atlanta criteria for severe acute pancreatitis. They determined the sensitivity, specificity, and positive and negative predictive values of the APACHE II score as a predictor of these criteria.
The researchers reviewed records of patients admitted to the University of Cincinnati Medical Center between 1994 and 1998 with acute pancreatitis.
The team’s exclusion criteria included referral from an outside hospital, immunocompromised state, and chronic pancreatitis.
| An APACHE II score of > 8 exhibited 50% sensitivity and 69% specificity.|
Overall, 74 consecutive patients met our inclusion criteria.
Of these 74 patients, 10 had a severe course, 7 developed only local complications, and 3 patients had systemic complications.
Pancreatic surgical intervention was required in 4 patients, and no deaths occurred.
The researchers found that an APACHE II score of > 8 exhibited 50% sensitivity and 69% specificity.
Furthermore, all patients with systemic complications, and 2 of 7 patients with only local complications had an APACHE II score of > 8.
Dr Thangam Venkatesan’s team concluded, “The prevalence of severity among our nonreferred patients with acute pancreatitis was less than previously reported”.
“The APACHE II scoring system exhibited reasonable sensitivity in predicting systemic complications and/or the need for surgery, with a low positive predictive value.”
“This most certainly is a function of the low pretest probability of severe pancreatitis.”
“Future studies attempting to identify predictive systems that triage patients in a more cost-effective manner should restrict their analysis to Atlanta criteria other than local complications.”